POLICY
Youth Homelessness A Call for Partnerships between Research and Policy Sean A. Kidd, PhD, C.Psych1 Larry Davidson, PhD2
ABSTRACT Homeless youth present significant challenges both to youth workers and policy-makers seeking to develop better prevention and intervention strategies. This article discusses the compelling need for researchers and policy-makers to make efforts to work collaboratively to develop improved social policy informed by research findings. MeSH terms: Homeless youth; health policy; stereotyping
RÉSUMÉ Les jeunes sans-abri présentent des défis considérables aux travailleurs auprès des jeunes et aux décideurs soucieux d'élaborer de meilleures stratégies de prévention et d'intervention. Cet article porte sur le besoin incontournable pour les chercheurs et les décideurs de se concerter pour mettre au point des politiques sociales améliorées, étayées par des résultats de recherche.
1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON 2. Program on Recovery and Community Health, Yale University, New Haven, CT Correspondence: Sean A. Kidd, Assistant Professor, McMaster Department of Psychiatry and Behavioural Sciences, Associate, Yale Program on Recovery and Community Health, Centre for Mountain Health Services – Rehabilitation, St. Joseph’s Healthcare, Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Tel: 905-522-1155, ext. 6312, Fax: 905-575-6088, E-mail:
[email protected],
[email protected] Acknowledgements: This work was supported with grants from the Canadian Social Sciences and Humanities Research Council. NOVEMBER – DECEMBER 2006
omeless youths are typically defined as a group of adolescents and young adults, ranging in age from approximately 12 to 24, who live in shelters, on the streets, in abandoned buildings, or who otherwise do not have an adequate place to dwell (stable, with appropriate shelter and amenities) that serves as a permanent home.1 These young people are concentrated primarily in large urban centres and, though accuracy of estimates regarding the extent of youth homelessness is questionable, statistics from the United States suggest that numbers are increasing, with at least one million youths thought to be homeless in North America at the present time.2 While there may be myriad reasons behind a given youth’s becoming homeless, the research literature has highlighted some common factors. These include young people being thrown out of, or running away from, homes in which abuse and neglect are occurring.3-5 Also frequent are histories of domestic violence, parental criminality and substance abuse, and poverty.3,5-7 On the streets, homeless youth face numerous serious risks. These include high rates of victimization8 and ongoing problems finding shelter and maintaining an appropriate diet.9 Drug use and dependence are common,10 as are sex trade involvement,11 criminality, 7 serious mental illness, 8,12 poor physical health and high incidences of communicable disease,13 and suicidality.14 Mortality rates are extremely high, with conservative estimates indicating rates in Canada of up to 11 times that of the general youth population15 (mortality rates up to 40 times greater than the average have been noted in the United Kingdom16) and suicide being the leading cause of death.17 Substantially less information is available regarding services provided to homeless youths. The few studies that have been conducted generally attest to the difficulty in providing effective services for this group that achieve lasting gains in mental and physical health domains. 13,18-20 The numerous and interacting risks accompanied by unstable living circumstances and structural barriers combine to hamper the effectiveness of any number of innovative and well-conceived interventions. Thus far, there is a lack of any clear distinction between the American and Canadian literature with respect to the etiology, risk, and intervention among homeless youths.
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Findings to date would not, however, suggest marked differences. Of the range of factors involved in youth homelessness, socio-cultural and policy issues have received the least attention in the mental and physical health literature. This circumstance prevails despite emerging evidence that social stigma at both public (insults, physical assaults, denial of employment and housing due to homeless status) and structural (multiple arrests, inadequate funding for services) levels can significantly heighten levels of risk and hamper intervention efforts.21,22 The picture in Canada regarding policy and legislation suggests numerous areas of difficulty. Ongoing problem areas that likely compound and contribute to the problem of youth homelessness include: • difficulty accessing income support,23,24 unemployment insurance and disability payments25 • increasing criminalization and disproportionate arrests26-28 • declines in affordable housing, difficulty accessing socially supported housing, increasing evictions25 • breakdown in continuity of care due to child welfare service age cutoffs (ranging from 16-19) 28 and youth services age cutoffs (typically 24)29 • a lack of services specific to the needs of homeless youths such as adequate discharge planning from health care and criminal justice systems.24 Also lacking are employment skills training programs,27 acute treatment centres (e.g., detox programs) and temporary housing, 27 and educational programs such as alternative high schools.30 The narratives of homeless youth reflect these barriers, being replete with descriptions of multiple arrests due to restrictions on their rights to use public spaces or solicit money, problems finding affordable housing or employment, and difficulties negotiating social assistance services.21 Given this situation, there would seem to be a compelling need for researchers to commence an examination of larger social processes and social policy as they affect homeless youth. The following represents a proposal for prevention and intervention efforts that might serve to better address youth homelessness. These recommendations emphasize linkages between research and policy. 446 REVUE CANADIENNE DE SANTÉ PUBLIQUE
Addressing the contexts from which youths run and are thrown out The difficulty in leaving the streets once a youth becomes entrenched in street culture18 suggests that the greatest impact might be made with youths at risk of becoming homeless. Avenues of prevention are, however, under-represented in the literature and in service provision initiatives.31 An important direction for future work lies in examining programs that serve to a) identify and intervene with youths at risk of becoming homeless and their families in various contexts such as schools and mental health service provision settings, b) reduce the likelihood of youths becoming homeless following problematic experiences in contexts such as child welfare and criminal justice systems – both common pathways into homelessness 32 and c) increase opportunities for impoverished children (e.g., after-school programs). Policy and social stigma Research and public policy both have the potential to substantially ameliorate the social conditions that contribute to the youth homelessness problem. Some proposed strategies in this area include the following: • In public statements, government representatives can claim some degree of collective responsibility for the homeless youth situation, citing failures in policy and publicly funded services – rather than individual deficits or behaviours – that have led to increasing numbers of children and youth on the streets. • Challenging legislation that results in the criminalization of homeless youth and hampers their ability to access public assistance and supported housing. These challenges may be undertaken either by legislators or through legal action. • Research can be used to highlight the extent of the social stigma faced by homeless youth, the erroneous foundations upon which stigma is based, and the damage caused by stigmatization and prejudicial policy/legislation. 26 These kinds of data – such as work which has shown disproportionate arrests of homeless adults for primarily non-violent, minor, and victimless crimes33 and findings that social stigma contributes to suicidality among homeless youth34 – can be used to undermine biased portrayals
appearing in media and policy and increase understanding of systemic factors as they influence the lives of homeless young persons. • More important, perhaps, is the direct impact that research can have on policy. In this arena, researchers have the potential to have a major constructive impact on the lives of homeless youth through careful examination of the various impacts of existing policy, analysis of the outcomes of emerging legislation, and evaluation of ways in which existing policy might be altered to allow for improved outcomes. Such an impact has been made previously in areas such as domestic violence, sexual harassment, and prejudice against sexual minorities.35 Pathways off the streets As noted above, along with the compelling need to develop an evidence base regarding the effectiveness of interventions for homeless youths, there needs to occur a careful review of funding practices and strategies in a manner informed by research. Current knowledge21,30 would suggest that the following strategies may represent a significant improvement upon existing practices: • Funding investigation/evaluation by multidisciplinary task forces comprised of researchers and stakeholders for the purpose of generating solutions ranging from interventions focussing on individuals to changes in legislation. • Providing funding that is commensurate with both the extent of the problem in terms of numbers of homeless youth and the complexity of their needs. This will include recognition, in ongoing evaluation of funded programs, of the need to measure “success” in a way that acknowledges the unique challenges of homelessness (i.e., success should not be measured solely by number of youth who become employed, return to school, and/or become housed, as success may also mean a youth surviving through the winter or using less harmful substances). • Providing sustained funding. A key to the effectiveness of interventions is the degree to which they do not resemble street existence or problematic home environments.29 Stated differently, adequate and sustained funding allows for consistency in service provision and programming and lowers staff turnover, VOLUME 97, NO. 6
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allowing for a thorough assessment of youth needs and the development of stable and trusting relationships with service providers.
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CONCLUSION At present, there are major gaps in knowledge transfer with regards to youth homelessness. Beyond publication in academic journals, there would appear to exist few examples of knowledge disseminated in practical formats to youth workers or used to inform policy development at any level. In addition to difficulties surrounding the transfer of existing findings, it is essential that research follows through on increasing calls for the development and examination of primary prevention efforts and attention to the impacts of social stigma and legislation as they impact this population. This need for academic researchers to move beyond the role of “knowledge gatherer” and engage in more active participation in policy development, evaluation, dissemination of practical and accessible knowledge, and advocacy is increasingly entering the forefront of critical examinations of various fields.36 REFERENCES 1. U.S. Department of Education. Report to Congress on final reports submitted by states in accordance with Section 724(b) (3) of the Stewart B. McKinney Homeless Assistance Act. Washington, DC, 1989. 2. Kidd SA, Scrimenti K. The New Haven homeless count: Children and youth. Eval Rev 2004;28:325-41. 3. Maclean MG, Embry LE, Cauce AM. Homeless adolescents’ paths to separation from family: Comparison of family characteristics, psychological adjustment, and victimization. J Community Psychol 1999;27:179-87. 4. Molnar BE, Shade SB, Kral AH, Booth RE, Watters JK. Suicidal behavior and sexual/physical
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7. 8.
9. 10.
11. 12. 13.
14. 15. 16. 17.
18. 19.
20.
21.
abuse among street youth. Child Abuse Negl 1998;22:213-22. Ringwalt CL, Greene JM, Robertson MJ. Familial backgrounds and risk behaviors of youth with throwaway experiences. J Adolesc 1998;21:241-52. Buckner JC, Bassuk EL. Mental disorders and service utilization among youths from homeless and low-income household families. J Am Acad Child Adolesc Psychiatry 1997;36:890-900. Hagan J, McCarthy B. Mean Streets: Youth Crime and Homelessness. Cambridge, UK: Cambridge University Press, 1997. Whitbeck LB, Hoyt DR, Bao W. Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents. Child Dev 2000;71:721-32. Antoniades M, Tarasuk V. A survey of food problems experienced by Toronto street youth. Can J Public Health 1998;89(6):371-75. Greene JM, Ringwalt CL. Youth and familial substance use’s association with suicide attempts among runaway and homeless youth. Subst Use Misuse 1996;31:1041-58. Kidd SA, Kral MJ. Street youth suicide and prostitution: A qualitative analysis. Adolesc 2002;37:411-30. Rotheram-Borus MJ. Suicidal behavior and risk factors among runaway youths. Am J Psychiatry 1993;150:103-7. Booth RE, Zhang Y, Kwiatkowski CF. The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents. Child Abuse Negl 1999;23:1295-306. Kidd SA. Factors precipitating suicidality among homeless youth: A quantitative follow-up. Youth & Society 2006;37:393-422. Roy E, Boivin JF, Haley N, Lemire N. Mortality among street youth. Lancet 1998;352:32. Shaw M, Dorling D. Mortality among street youth in the UK. Lancet 1998;352:743. Roy E, Haley N, Leclerc P, Sochanski B, Boudreau J, Boivin J. Mortality in a cohort of street youth in Montreal. JAMA 2004;292:56974. Barry PJ, Ensign J, Lippek SH. Embracing street culture: Fitting health care into the lives of street youth. J Transcult Nurs 2002;13:145-52. Cauce AM, Morgan CJ, Wagner V, Moore E, Sy J, Wurzbacher K, et al. Effectiveness of intensive case management for homeless adolescents: Results of a 3-month follow-up. J Emot Behav Dis 1994;2:219-27. Thompson SJ, Pollio DE, Constantine J, Reid D, Nebbitt V. Short-term outcomes for youth receiving runaway and homeless shelter services. Res Soc Work Pract 2002;12:589-603. Kidd SA. Street youth: Coping and interventions. Child Adolesc Social Work J 2003;20:235-61.
22. Shissel B. Blaming Children. Halifax, NS: Fernwood, 1997. 23. Gaetz S, O’Grady B. Making money: Exploring the economy of young homeless workers. Work Employ Soc 2002;16:433-56. 24. Raising the Roof. From Street to Stability: A Compilation of Findings on the Paths to Homelessness and its Prevention. Toronto: Raising the Roof, 2001. 25. City of Toronto. Toronto Report Card on Homelessness. Toronto: City of Toronto, 2001. 26. O’Grady S, Greene C. A social and economic impact study of the Ontario Safe Streets Act on Toronto squeegee workers. Online J Justice Stud 2003;1. 27. Eberle M. The Relationship Between Homelessness and the Health, Social Services and Criminal Justice Systems: A Review of the Literature. Vancouver: British Columbia Ministry of Social Development and Economic Security, 2001. 28. Novac S, Serge L, Eberle M, Brown J. On Her Own: Young Women and Homelessness in Canada. Ottawa: Status of Women Canada, 2002. 29. Kidd SA, Miner S, Walker D, Davidson L. Stories of working with homeless youth: On being “mind-boggling”. Children and Youth Services Rev (in press). 30. Josephson GJ. Relating homelessness to education, employment and income support: A review of Canadian Literature. Available online at: http://policyresearch.gc.ca (Accessed June 9, 2005). 31. Karabanow J, Clement P. Interventions with street youth: A commentary on the practicebased research literature. Brief Treatment and Crisis Interv 2004;4:93-108. 32. Karabanow J. Making organizations work: Exploring characteristics of anti-oppressive organizational structures in street youth shelters. J Soc Work 2004;4:47-60. 33. Snow DA, Baker SG, Anderson L. Criminality and homeless men: An empirical assessment. Soc Problems 1989;36:532-49. 34. Kidd SA. “The walls were closing in and we were trapped”: A qualitative analysis of street youth suicide. Youth Soc 2004;36:30-55. 35. Keuhl SJ. Seeing is believing: Research on women’s sexual orientation and public policy. J Soc Issues 2000;56:351-59. 36. Prilleltensky I. Values, assumptions, and practices: Assessing the moral implications of psychological discourse and action. Am Psychol 1997;52:517-35. Received: October 19, 2005 Accepted: March 5, 2006
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